As the nonpartisan Congressional Budget Office reaffirmed in a new report this week, the U.S. national debt will skyrocket in the coming decades without significant changes to current law. By 2023, gross debt will soar from $16 trillion to $26 trillion, and will grow “sharply” thereafter.

The CBO attributes this to a combination of the aging of the population and rising health care costs. Medicare is the program where these two factors converge. With more and more seniors demanding increasingly expensive medical care, the program has become unsustainable. Even though these plain facts have been staring him in the face, more than four years into his time in office, President Obama has not only refused to produce a plan that puts the program on a sustainable trajectory, but he’s flouted the law in doing so.